Twenty-six percent of the population twenty years and over have destructive periodontal disease (> 4 mm loss of bone height). Alveolar bone height correlates well with subsequent tooth loss. Moreover, it has been found that periodontal disease correlates with other diseases, e.g., atherosclerosis and diabetes. Proper diagnosis, treatment, maintenance, and patient education result in the reduced effects of periodontal disease and ultimately improve the quality of life of the patient. Yet for the vast majority of the U.S. and world population, clinical assessment of periodontal status is subjective and performed by qualitative means, i.e., visual inspection and by using periodontal probes, with little focus on patient education. In Phase 1, Imagination Software Corporation (ISC) developed a reliable, sensitive, easy to use, and rapid system for measuring alveolar bone height and its change consisting of (a) a user-friendly interface for manual indication of the cemento-enamel junctions (CEJ) and crest-tooth junctions of a tooth, (b) image analysis techniques to improve the accuracy of the indications, removing the onus of careful indication, and calculate the bone height along the distal and mesial edges of a tooth, and (c) methods to determine bone height change. In Phase 2, a prototype system will be developed that will perform a fully automated full-mouth (64 sites) crest height analysis in less than one minute per patient. The system uses digital/digitized radiographs acquired as part of standard dental care are required, i.e. no additional radiation dose to the patient, is based on the technology developed in Phase 1 (for a single site), and requires user interaction after image input. This will be achieved by coupling th Phase 1 technology with automated identification of the teeth and their numbers. This system will be evaluated in experimental and clinical settings, using feedback from dentists to make enhancements and improve the ease of use and clinical utility of the software. Working with the end users of the product in its development will ensure that it will enhance the clinical practice without affecting clinical workflow, eventually becoming an essential part of their practice. The final product will allow a simple, rapid, precise, and accurate assessment of the periodontal bone status of all teeth using radiographic images, resulting in a new first line of defense in the diagnosis of destructive periodontal disease. The system will give all dentists the ability to detet and treat the disease at an earlier stage and allow them to better monitor maintenance patients receiving treatment for the disease. When incorporated into existing image viewing software that dentists use and are already familiar with, ISC's system will be adapted easily into practice and achieve a strong market penetration, which (coupled with accurate, precise, and reliable data) means improved dental care for millions of patients. PUBLIC HEALTH RELEVANCE: Alveolar bone height correlates well with subsequent tooth loss. The goal of this proposal is the development and implementation of an automated, reliable, sensitive, easy to use, and rapid product for the measurement of alveolar bone height and its change for every tooth in every patient. When used routinely in dental practice, this system will result in a new first line of defense in the diagnosis of destructive periodontal disease, thus giving the dentist the ability to detect and treat the disease at an earlier stage and improve thei ability to monitor maintenance in patients receiving treatment.